Healthcare Provider Details

I. General information

NPI: 1467516740
Provider Name (Legal Business Name): MANORCARE HEALTH SERVICES BOULDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 PALO PKWY
BOULDER CO
80301-1540
US

IV. Provider business mailing address

2800 PALO PKWY
BOULDER CO
80301-1540
US

V. Phone/Fax

Practice location:
  • Phone: 303-440-9100
  • Fax: 303-440-9251
Mailing address:
  • Phone: 303-440-9100
  • Fax: 303-440-9251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1295
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1992742258
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerNPI
# 2
Identifier63936364
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: MR. ANTHONY HANLON
Title or Position: ADMINISTRATOR
Credential:
Phone: 303-440-9100